Anterior Cruciate Ligament Reconstruction with the Leeds-Keio Artificial Ligament

Abstract

The Leeds-Keio (L-K) artificial ligament, developed for knee ligament reconstruction, is made of polyester with a maximum tensile strength of 2200 N. This implant works not only as a ligament but also as a scaffold onto which natural tissue grows from synovium. In an animal experiment, each strand of the L-K ligament was covered with new tissue by 2-3 weeks after anterior cruciate ligament reconstruction. Eight weeks postoperatively, abundant fibrous tissue with extensive vascularity covered the implant, which was still histologically immature. After 16 weeks, vascularization and tissue induction began to subside, and histologic analysis showed dense fibers running longitudinally and parallel. By 36 weeks, the new ligament looked like a natural anterior cruciate ligament, although histologically more cells could be seen than in the natural ligament. This maturation was observed only when the substitute was implanted under good tension. Clinically, the surgical procedure has been improved over the past 10 years, to the current practice in which the tape-in-tube double L-K ligament employs a small piece of autogenous tissue to promote early tissue induction and maturation. Using this practice (n = 135), more than 85% of the patients were satisfied subjectively, objectively, and arthroscopically at the 5-year postoperative FU period. Few patients had joint effusion postoperatively. Sacrifice of autogenous tissue is minimal. The patient can return to activities of daily living within 2 weeks, and more than 50% of them to sports within 10 weeks, and the new ligament is expected to keep its function for a long period as ingrowth completes the structure biologically.